Emergency Medicine - Burns: By Paul Olszynski M.D.

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Emergency Medicine – Burns
Whiteboard Animation Transcript
with Paul Olszynski, MD
https://medskl.com/Module/Index/burns

The term ‘burn’ encompasses a range of tissue injuries that includes thermal, electrical, chemical, and radiation injuries. Common to all of these is the destruction of cellular membranes.

Thermal burns are caused not by any one substance, but rather by the temperature of that substance. They can be further classified as either hot or cold injuries.

Electricity can cause extensive injury to any tissue through which it travels. Electrical burns can be difficult to identify initially because the surface tissues may appear normal despite extensive damage hiding below.

Chemical Burns are caused by substances that are either basic or acidic. These substances disrupt cellular membranes, resulting in cellular dysfunction, leakage, and ultimately cell death. It is critically important to recognize chemical injuries early in order to stop further injury through decontamination.

Radiation burn injuries are caused by exposure to radioactive materials. These burns only occur when radiation levels are extremely high.

After identifying the cause, it is important to determine the severity of injury. The severity of a burn injury is related to the depth of burn and the extent of involvement, represented as the percent of body surfaced burned. 1st degree burns include the epidermis only. 2nd degree burns include portions of the dermis. 3rd degree burns involve all skin layers and beyond.

In the setting of high temperature thermal and chemical burns, the risk of inhalation injury must be evaluated. Burn injuries to the face, soot on the mucosa, and pharyngeal edema are signs that the patient’s airway has been exposed to high temperatures and pose a risk to the patient’s airway.

Treatment must take in account both cause and extent. Burn victims are at risk of dehydration as well as edema, so intravenous therapy must be administered carefully. Risk of infection must also be considered with appropriate prophylaxis when indicated. Finally, burn injuries are painful, so analgesia is important.